| NPI | 1619467677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY GATES Nurse Practitioner 248-842-3755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2020-01-17 |